Two very different views are emerging about The Canberra Hospital. The public has very little chance of deciding where the truth lies and therefore whether the politicians they vote for are doing a good job.
On one hand, we have a line of research from past Grants Commission reports, a more recent Productivity Commission inquiry and several other consultants’ reports. These suggest that The Canberra Hospital is costing up to 50 per cent over the national average and that the extra cost can be put down to inefficiencies of one sort or another and higher incomes than necessary for doctors, administrators, nurses and others. Along with this research are suggestions that The Canberra Hospital does not do a brilliant job medically compared to hospitals that can specialise more in Sydney. These hospitals have the ability to attract the very best in their fields because of the degree of specialisation and the volume of work in the specialisation.
On the other hand, a very detailed study by the Australian Salaried Medical Officers Federation paints a different picture. It shows a hospital that works in a different way from virtually every other hospital in the country. The Canberra Hospital takes the most serious cases from a very large area in NSW. Moreover, as it is the only major hospital for miles around it does not specialise, unlike hospitals in Sydney and Melbourne. It tends, therefore, to treat a patient from start to finish as one event. In short, Canberra hospital episodes (separations, in the jargon) tend to be longer, more complex and more comprehensive than the average in other states. Further, hospitals in larger cities had lower cost structures.
Cost per separation is a foolish measure, according to the ASMOF research. Measured a different way, Canberra is doing very well, thank-you very much.
The other element to this view is the large body of anecdotal evidence from former patients saying the doctors worked miracles, the nurses were veritable Nightingales, and their hospital experience was a paragon of efficiency and humanity. Further, there is the fact that the teaching school has resulted in the hospital doing procedures that a few years ago no-one would ever imagince could be done in Canberra, reducing costs and anxiety for Canberra families.
With these competing views, it is hard to pick whether it is Canberra Hospital trick or Canberra Hospital treat.
Amid this, the hospital administration, the territory department of health and ultimately the Legislative Assembly have to fashion a budget.
Health Minister Michael Moore wants the hospital to stay within its $231 million budget, about the same as it had last year.
The budget has been blown by about $10 million each year for the past four years. The past financial year’s figures have not been made public, but the public stoush between the hospital administration and the health department earlier in the year indicated the blow-out would be between $5 million and $10 million. That raises the question of whether it was a sensible budget in the first place. If the hospital being given enough money to do the task of meeting the region’s hospital-care needs? If it is, the further question is raised as to whether administrators are being effective in getting costs and expenditure under control.
Health spending can be virtually open-ended. Patients might imagine no expense is spared. In fact, health is a rationing exercise. Most opinion polls, letters and talk-back on the issue indicate that the public is happy to pay higher taxes for better health care. But the spending must be on health care, not on poor administration.
The trouble with the hospital over-spending its budget, is that the money has to come from other health areas.
The various departmental heads at the hospital have together sought $17 million more than is on offer for 1999-2000. Doctors have intimated that if they do not get it, patient care will be affected. Essential services like round-the-clock blood testing could be in jeopardy, possibly endangering lives, they say.
The trouble with claims from the medical profession is that the public tends to treat them as gospel, and the government is then in a very difficult position. It can be accused of killing people if it does not pay up. The fact the medical profession has its own interests as well as its patients’ interests at heart is often overlooked.
At present the budget process at the hospital seems deeply flawed. The Government says “”hold to the Budget you blew out last year by up to $10 million”. In effect, that means cutting hospital spending by about $10 million next year, about 4.5 per cent. This at a time when health costs are going up with higher treatment technology and broader diagnostic techniques. The demand to cut last year’s spending comes in an environment of ignorance and doubt about the hospital’s funding needs.
The conclusions the Government drew from the research by the Productivity Commission and others had now been seriously challenged by the ASMOF research. It seems silly to conduct serious budget discussions until that research is either debunked or acknowledged.
In the meantime, some public engagement in hospital funding might be promoted. Just as the insurance levy caused a greater deal of public scrutiny, perhaps a hospital excess levy might excite similar debate – the levy to remain until the hospital comes within a certain percentage of national averages or until it is proven that to run a hospital in this catchment you need more money than average.
Until that happens, the health of our wallets will be compromised by doctors, or the health of bodies will be compromised by governments.
Ignorance is dangerous.